Field
Various medical centers, other than hospitals, may benefit from having combined surgical and fixed imaging services. For example, ambulatory surgical centers may benefit from having a hybrid operating room that combines such surgical and fixed imaging services.
Description of the Related Art
Combined surgical and fixed imaging services in an operating room have been provided only in hospital facilities. Hospital facilities are generally designed with a variety of special features to fulfill strict safety requirements that add significantly to the cost to build and operate the hospital facility. For example, hospitals are typically constructed to adhere to strict building codes. Hospitals, for example, are classified according to International Building Code (IBC) as Institutional Group I-2, meaning occupancy shall include buildings and structures used for medical care on a 24-hour basis for more than five persons who are incapable of self-preservation. Hospitals typically also have heightened requirements regarding fire control, such as specific required building materials, in part because the occupants of the hospital are often incapable of self-preservation, as noted above.
Furthermore, hospitals traditionally include a variety of equipment. Normally, a hospital includes a number of hospital beds. Similarly, hospitals typically include patient rooms, which may house those hospital beds, and patient restrooms. Often, the size of a hospital is given as the number of beds the hospital has. Furthermore, hospitals also often include other facilities, such as a pharmacy, a lab, a morgue, and facilities providing radiology services, infection isolation, dietary services, linen services, emergency services, and the like.
Additionally, hospitals normally are required to have disaster prevention provisions for the primary structure and services as well as a disaster response plan, policy, and capabilities. Likewise, in view of the size of hospitals, hospitals often include central services (for example, central sterilization services), materials management, environmental services, and engineering services.
According to conventional wisdom, combined surgical and imaging services in an operating room are best provided in a hospital context. For example, imaging equipment is often heavy and has substantial power requirements. Hospitals, with their massive infrastructure, can readily accommodate such requirements. Also, imaging equipment often requires shielding due to the use of radiation, such as x-rays. Again, the infrastructure of a hospital is conventionally thought to be the only medical facility infrastructure adapted to safely accommodate such a purpose. For example, the thick concrete walls and floors of a typical hospital can help to block radiation.
Operating rooms for providing combined surgery and fixed imaging in a hospital are comparatively large. For example, a typical combined surgical and fixed imaging surgery room in a hospital may be in the range of 800 to 1000 square feet. For example, operating rooms in a hospital need to be of such comparatively large size in order to accommodate the performance of up to twenty to thirty different surgical specialties and sub-specialties as may normally be performed in a hospital, such as cardiac, thoracic, vascular, obstetrics, gynecological, orthopedic, podiatric, urologic, otolaryngologic, neurosurgery, trauma, ophthalmology, gastrointestinal, transplant, general surgery, colorectal surgery, hand surgery, endocrine surgery, breast surgery, plastic surgery, head and neck surgery, surgical oncology, pediatric surgery, spine surgery, oral maxillo facial surgery and so on.
Furthermore, hospitals typically are required to have particularly robust infectious vector isolation as well as high quality and sophisticated nurse call systems. Hospitals also have requirements for control of airborne sound transmission and water temperature requirements. Hospitals also normally have medical gas systems with strict requirements on their number and amount of testing. Likewise, elevators in hospitals are required to be large to accommodate gurney traffic.
As mentioned above, hospitals typically have specific fire code requirements. For example, hospital construction materials must be non-combustible and must provide for patient and staff safety in case of an emergency. Because hospitals are viewed as essential in case of a disaster, hospitals must be able to withstand greater events, such as earthquakes, floods, and the like. The structure also needs to be designed to provide the option of defending the structure in place rather than evacuating the structure.
To support such objectives, hospitals may be required to have redundancy of critical services, such as heating, ventilation, and air conditioning (HVAC), power, water supply, water heating, and the like. Furthermore, the materials from which the building is constructed, including the finishes for interior walls and ceilings, must comply with strict fire requirements, such as a very low flame spread index. Other similar reinforcements and protections may likewise be required. In short, a hospital is normally required to have a significantly enhanced infrastructure.
By contrast, conventional ambulatory surgical centers (ASCs) can be constructed in office buildings. These buildings have various code requirements, but typically these requirements are much less strict, and therefore, can be fulfilled with significant cost savings as compared to the cost to build a hospital. For example, an IBC class B structure, which may house an ASC, will have significantly less strict construction requirements than an IBC class I-2 structure, typically associated with the construction of a hospital. Similarly, the air change requirements for ASCs and other requirements may be much less strict for ASCs than for hospitals. In this discussion, class B can refer to use and occupancy classification, such as described in International Building Code (2012 version), Chapter 3, section 304, “Business Group B.”
Likewise, ASCs typically do not require a pharmacy, a lab, a morgue, linen services, dietary services, and the like. Indeed, ASCs normally do not have any hospital beds, because it is not expected that the patients will be staying overnight.
Similarly, typical operating rooms in ASCs may be smaller than in hospitals. For example, an operating room in an ASC may be less than 600 square feet and possibly as small as 425 square feet. Furthermore, an ASC may generally offer only one to ten different surgical specialties, rather than the twenty to thirty surgical specialties offered in a typical hospital.
ASCs can herein or otherwise be described in various ways. For example, ASCs can also be referred to as ambulatory surgery center, clinics, outpatient surgical centers, and the like. Thus, herein or otherwise the term ASC can refer generally to ASCs, clinics, outpatient surgical centers and similar structures.
Office-based labs (OBLs) are another kind of non-hospital building in which medical procedures may be performed. OBLs may be limited as to the type of procedures that can be performed. For example, general anesthesia cannot be provided in an office setting in most states. Additionally, an office may lack the ability to provide an environment that prevents infection. Likewise, the use of an OBL may be limited to the physician's specialty of practice.
As an example, safely placing a patient in a prone position on the operating room table may not be possible in an office, as the ability to protect the airway is significantly impaired and may require placement of a breathing tube. Such placement of a breathing tube may, for safety reasons, require an ambulatory surgery center.
Most procedures performed in an OBL do not require general anesthesia, can be performed without an incision and are relatively short in duration. OBLs are typically established by cardiologists and pain groups, as their procedures do not require general anesthesia and may be performed percutaneously. Because OBLs do not require separate licensure they are not required to have back up power resources to permit continued surgery and recovery of patients. Moreover, such OBLs can include procedure rooms, as opposed to operating rooms, with typically one procedure room.
Typically a given OBL would be used by a limited number of physicians focused on a specific area of medicine: pain, cardiology, and so on. In addition, registered nurses are not required in the care of a patient in such an environment. Given that separate licensure is not required, the design of an OBL is not reviewed by a licensing body and is dictated by the space of the physician's environment and needs. It is not unusual for a medical practice to combine several exam rooms into a procedure room.
Since most OBLs have procedure rooms, they have structural and environmental differences from an operating room as defined in “Guidelines for Design and Construction of Hospitals and Outpatient Facilities.”
Operating rooms may have various differences from procedure rooms. Operating rooms are typically located in a restricted area, have monolithic floors, walls and ceilings that are scrubbable and resistant to cleaning chemicals, have their own dedicated air handlers to prevent recirculation of air, have positive pressure ventilation to prevent entry of external air into the operating room, and have back up power to permit continuity of surgery in the operating room. Procedure rooms are typically located in an un-restricted or semi-restricted area, tend to have drop grid ceilings, may have tiled flooring, typically do not have a separate air handler, and have no specific ventilation requirements.
The national practitioner identifier program identifies ASCs with a separate taxonomy. ASCs have a specific taxonomy code of 261QA1903X as specified in the National Provider Identifier (NPI) by the Centers for Medicare and Medicaid Services (CMS) under the National Plan and Provider Enumeration System (NPPES). General Acute Care Hospitals have the taxonomy code of 282N00000X. Physicians' offices, OBLs, and Independent Diagnostic Testing Facilities (IDTFs) have taxonomy codes specific to their specialty such as Family Medicine—207Q00000X, Internal Medicine—207R00000X, Cardiovascular Disease—207RC0000X, Diagnostic Radiology—2085R0202X. ASCs are also distinguished by their place of service code “24”, whereas as hospitals are place of service code “22”, and an office is place of service code “11”.